title: The use of near-infrared spectroscopy during an extubation readiness trial as a predictor of extubation outcome.
abstract: OBJECTIVE
  To determine whether the measurement of cerebral and somatic regional oxygen saturation during an extubation readiness trial predicts extubation failure in postoperative cardiac patients.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary care center cardiac ICU.
  
  
  METHODS
  Pediatric patients 1 day to 21 years old following cardiac surgery for congenital heart disease. Patients were included if they were intubated for greater than 12 hours and were undergoing an extubation readiness trial.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data collection included patient demographic, procedural, laboratory, and physiologic variables. Regional oxygen saturation values were recorded using near-infrared spectroscopy at baseline, during a 2-hour extubation readiness trial, and in the first 2 hours postextubation. Ninety-nine extubation readiness trials were conducted in 79 patients. Adjusting for baseline somatic regional oxygen saturation, logistic regression analysis demonstrated that patients with a decline in their minimum somatic regional oxygen saturation of at least 10% during an extubation readiness trial had a 6-time increased odds of extubation failure (p = 0.02; 95% CI, 1.26-29.8). Receiver-operating characteristic curve analysis demonstrated that a 12% decline in the minimum regional oxygen saturation best predicted extubation failure with 54% sensitivity and 82% specificity.
  
  
  CONCLUSIONS
  A 12% decline in somatic regional oxygen saturation during an extubation readiness trial is associated with an increased risk of extubation failure following a successful extubation readiness trial. The addition of somatic regional oxygen saturation measurements to an extubation readiness trial may improve our ability to predict extubation outcome.
authors.affiliation: Division of Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA. Cortneybfoster@aol.com
authors.forename: Cortney B
authors.initials: CB
authors.lastname: Foster
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarter
authors.forename: Yao I
authors.initials: YI
authors.lastname: Cheng
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D060666:Airway Extubation; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010092:Oximetry / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D019265:Spectroscopy, Near-Infrared; D015300:Ventilator Weaning / Q000379:methods*; D055815:Young Adult